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How long should I expect to be in treatment?
CBT is designed to be a short-term treatment, lasting for roughly 12-20 sessions.
However, there are a number of situations in which CBT may take longer:
- If you are experiencing multiple problems and therefore wish to work on multiple treatment goals
- If your problem is particularly complex
- If, once you effectively work on a specific problem, you wish to discuss more general issues. For example, once “Linda’s” acute eating problems were under control, she asked that we discuss her feelings of stagnation in her job and her issues with procrastination.
- If something unanticipated occurs during treatment. For example, “Ben” was working on his OCD when his wife announced that she was seeking a divorce. We spent much time in treatment helping Ben cope with his divorce.
There are also situations in which CBT treatment can be relatively short (i.e. 4 weeks). For example, certain phobias can be effectively treated in just a few short sessions.
What are the success rates for CBT?
Numerous studies have demonstrated the efficacy of CBT for the treatment of a multitude of psychiatric diagnoses, including anxiety disorders, bulimia nervosa, binge eating disorder, and depression. That said, there is no guarantee that treatment will work for any one individual.
While we cannot predict with certainty who will thrive in CBT, there are a number of factors that often affect treatment progress. These include:
- Motivation for treatment. CBT is a labor-intensive form of psychotherapy. You are asked to face your fears head-on and take active steps towards solving your problems. Those individuals who do best in CBT are those who are highly motivated to work on their difficulties. That being said, as CBT work is difficult, even the most motivated people usually feel ambivalent about change at some time during treatment. This ambivalence about change is addressed during sessions.
- Homework completion. CBT sessions with your therapist are brief; most of the work occurs at home, when you implement change strategies discussed in sessions. Studies have shown consistent homework completion to be a critical factor for success in CBT. We have also found this to be true in our own work.
- Time to devote to treatment. As mentioned above, most of the work in CBT occurs at home. It requires that you take time out of your day to implement new strategies and tools. Those individuals who do best in CBT treatment are those who prioritize their treatment and set aside time each day to work towards their treatment goals.
- Consistent session attendance. Not surprisingly, the more often you come for sessions, the more quickly you will reach your treatment goals. We have worked with people in the past who frequently cancel sessions and then feel frustrated that they are not making the progress they’d like to be making. It is important to make sessions a regular part of your schedule.
How do I know if the therapy I’m currently receiving is “CBT?”
Cognitive-behavioral therapy can be distinguished from other forms of psychotherapy based on its emphasis on active problem solving. CBT therapists focus less on what originally caused a problem and more on what is currently maintaining a problem. A CBT therapist will teach you explicit strategies for managing your problems when they arise. Typically, CBT therapists will ask you what your treatment goals are and design a treatment plan to meet these goals. Most treatment plans entail homework; you will be asked to try out new therapeutic strategies at home.
Can I work with you and with a non-CBT therapist at the same time?
Yes. In our experience, there are times when this works very well, and times when this does not work well.
We believe that a dual therapist situation works best when the CBT therapist and the non-CBT therapist are working on different therapeutic goals. For example, we recently provided “Jennifer” with a specific CBT treatment, Exposure and Response Prevention, to help her manage her OCD. With her other therapist, she focused on her complicated relationship with her parents.
A dual therapist situation does not work well when a person is working on the same issue with both therapists and receiving different messages from each therapist. We once worked with “Bob,” who had Panic Disorder. As part of his CBT work, we encouraged him to face the situations he feared in a gradual fashion. His other therapist encouraged him to use distraction techniques when his anxiety became acute. “Bob” was understandably very confused by these conflicting messages.
When we work with someone who has another therapist, we ask him/her for permission to contact the other therapist. If permission is granted, we work with the therapist to clarify how we can best help the person achieve his/her therapeutic goals.
Can I take medications, like antidepressants or anti-anxiety agents, at the same time I’m in CBT treatment?
Yes. We work with many people who take medications while engaging in CBT. If you do wish to start taking medication, we highly recommend that you see a psychiatrist rather than your general practitioner. Psychiatrists (and particularly those who specialize in psychopharmacology) are extremely knowledgeable about psychiatric medications and can work with you to find an optimal medication(s) for you at an optimal dose. If given permission, we will contact your psychiatrist to ensure that we are on the same page regarding your treatment, and that he/she understands what you are working on in therapy.
Where can I get more information about psychiatric medications?
A good place to start is Medline Plus, a website with information about specific drugs, including indications for use and side effects. Again, it is best to consult with a psychiatrist or psychopharmacologist before starting a psychiatric medication.